Anxiety is common during perimenopause (the time leading up to menopause). This is especially true for people who have a history of anxiety.

Many women expect changes in their periods while going through perimenopause and menopause. However, they may be surprised by how much their moods can change. “I wish I knew about all the symptoms that surprised me,” a woman surveyed by ThisIsMenopause wrote. “I had no idea about the anxiety, pain, and stomach issues.”

Anxiety can significantly affect everyday life and may require medical treatment. It can also worsen some menopause symptoms. The good news is that effective treatment options are available.

What Is Anxiety?

Anxiety refers to a feeling of fear or uneasiness. It may feel like a sense of dread or being overwhelmed. Most people feel anxious from time to time, and anxiety can even be helpful. For example, feeling anxious about a big work presentation may motivate you to spend more time preparing. However, chronic anxiety or an anxiety disorder can interfere with daily life and lower your quality of life.

Common symptoms of anxiety include:

• Racing thoughts
• Restlessness
• Rapid heartbeat
• Sweating
• Tense feelings
• Difficulty concentrating
• Dizziness
• Shortness of breath
• Unexplained pain

Untreated anxiety can make it hard to function. You may avoid certain situations or skip activities you enjoy. Caffeine or stimulant medications may make your symptoms worse. Anxiety is common, but that doesn’t mean you have to live with it. Lifestyle changes, medications, and therapy can help you manage symptoms and improve your mood.

How Does Anxiety Affect Women in Perimenopause?

In one survey of nearly 6,000 women, about 95 percent reported a negative change in their mood or emotions since beginning perimenopause, and 86 percent indicated feeling anxious or stressed.

Perimenopause usually occurs during an already demanding time of life. You may be caring for your children, parents, spouse, or other loved ones. Trying to balance your regular obligations — both at home and at work — while dealing with bothersome and confusing symptoms can be challenging. “I had anxiety and depression before menopause; the changes associated with menopause increased these symptoms,” a woman told ThisIsMenopause.

Experiencing an adverse life event, such as the loss of a loved one or a career change, during perimenopause also increases your risk of anxiety and depression.

Anxiety Symptoms in Perimenopause

“It’s another level of mood swings: anxiety, stress, depression,” one woman shared with ThisIsMenopause. During perimenopause, you may notice several mood changes, including:

• Mood swings
• Irritability
• Anger
• Nervousness
• Sleep problems
• Stomach upset
• Difficulty remembering details

Sleep problems during perimenopause may be due to hormonal changes and symptoms like hot flashes and night sweats. Interrupted or low-quality sleep can worsen anxiety, affecting you both emotionally and physically. After a night of poor sleep, you may feel more irritable and less patient with yourself and others. “I wish I had known that I would feel anxious and overwhelmed and be unable to sleep,” one woman surveyed by ThisIsMenopause said.

A 2024 study found that women are more likely to experience anxiety and depression during perimenopause than during menopause. This may be related to the major hormonal changes that occur during this time. During perimenopause, levels of estrogen and progesterone fluctuate significantly and eventually decline. These changes can affect serotonin, a neurotransmitter (brain chemical) that helps regulate mood. When serotonin levels dip, it’s common to experience mood changes such as worry, sadness, or anger.

Once hormone levels stabilize after menopause, some people notice fewer symptoms of anxiety and depression. You have officially reached menopause when you’ve gone 12 months without a period for no other medical reason.

Although anxiety and mood changes are common during perimenopause, severe depression or thoughts of suicide require immediate care. Seek medical care right away if you’re concerned about your mood or safety.

Note: If you or someone you know needs help, you can contact the 988 Suicide & Crisis Lifeline by calling or texting 988 or chatting online.

How Is Anxiety Treated During Perimenopause?

If you’re bothered by mood changes, talk with your healthcare provider. It can be hard to tell whether your anxiety is caused by hormonal changes, other factors, or a combination of both. No matter the cause, you deserve support. A variety of treatment options may help you feel more like yourself again.

Lifestyle Approaches

Your healthcare provider may suggest lifestyle changes, such as:

• Exercising regularly
• Eating a nutrient-dense diet
• Getting enough quality sleep
• Managing stress
• Spending time with friends and loved ones
• Avoiding smoking
• Limiting alcohol

Small steps, such as starting a daily walking routine or going to bed earlier, can boost your mood and ease anxiety symptoms.

Talk Therapy

Along with lifestyle changes, talk therapy may help. One effective approach for anxiety is cognitive behavioral therapy (CBT). CBT focuses on identifying anxious thoughts and unhelpful behaviors, then building healthier coping strategies.

Medication

If lifestyle changes and therapy aren’t enough, your healthcare provider may also recommend medication. Options may include:

• Antianxiety medications
• Sleep medications
• Hormone therapy

Hormone therapy — also called menopause hormone therapy or hormone replacement therapy (HRT) — uses medications that contain estrogen, progesterone, or both. Starting hormone therapy early in perimenopause may help reduce symptoms of anxiety and depression. However, more research is needed to fully understand how HRT affects anxiety.

Hormone therapy comes in several forms, including pills, skin patches, vaginal rings, and topical creams. Talk with your healthcare provider about which type and dose may be right for you.